基于Web of Science数据库近5年小儿肝移植研究热点知识图谱分析

目的 探究2016—2020年Web of Science核心数据库小儿肝移植研究热点内容.方法 下载Web of Science核心数据库数据作为本研究数据来源,通过Vosviewer和Citespace软件可视化分析近5年来小儿肝移植学科的发文情况、研究单位、核心研究作者、期刊分布、研究关键词及相关的聚类分析.结果...     

肝移植后丙型病毒性肝炎复发治疗时获得持续病毒应答的影响因素

Objective To investigate the efficacy of pegylated interferon (Peg-IFN) plus ribavirin to treat hepatitis C virus (HCV) recurrence, and analyze possible factors associated with sustained viral responses (SVR). Methods The enrolled 39 patients, who had recurrence of hepatitis C after liver transplantation and received antiretroviral therapy, were analyzed. Treatment was discontinued in 21 patients due to side effects, and the remaining 18 patients [13 males, 5 female,median age of 54 (27-67) years, treatment duration of 25-105 weeks)] were subjected to whole standard treatment. During the treatment, HCV RNA was measured at 4, 12, 24, and 24 weeks after HCV negative change as well as drug withdrawal. SVR was defined as HCV RNA negativity within 24 weeks after the drug withdrawal. The following variables were analyzed: ages, gender,pretreatment viral load, genotype, early viral response (EVR), levels of alanine aminotransferase before treatment and their association with SVR. Results The mean treatment duration was 57weeks with an SVR achieved in 4/18 (22. 2 %). Statistical analysis revealed that the genotype of non1B (P=0.023), RNA ＜106 copy/ml (P= 0. 044) before treatment and EVR (P=0.019) were the variables associated with SVR. Conclusion Genotype of nor-1B, low level RNA before treatment and EVR were the effective predictors of interferon antiviral therapy for recurrent hepatitis C after liver transplantation.     

肝移植后丙型病毒性肝炎复发治疗时获得持续病毒应答的影响因素

目的 探讨聚二乙醇干扰素治疗肝移植后丙型病毒性肝炎复发的效果,分析影响产生持续病毒应答率(SVR)的因素.方法 将肝移植后丙型病毒性肝炎复发并使用聚乙二醇干扰素α-2a进行抗丙型肝炎病毒(HCV)治疗的39例患者纳入研究,其中有21例因为抗HCV治疗无效或发生不良反应而中途停药,其余18例接受了全疗程规范治疗.18例患者中,男性13例,女性5例,平均年龄54岁(27～67岁),疗程25～105周.治疗后4、12、24周,病毒转阴后24周及停药后24周,检测HCV RNA的复制水平.停药后24周HCV RNA复制持续阴性为产生SVR.对患者年龄,性别,治疗前HCV RNA水平,HCV基因型,是否获得早期病毒应答(EVR),治疗前血清AST水平等因素与获得SVR的相关性进行分析.结果 有4例(22.2%)患者获得了SVR,其平均治疗周期为57周.经统计分析显示,HCV基因型为非1B型(P=0.023),治疗前HCV RNA载量＜106拷贝/ml(P=0.044),以及获得EVR(P=0.019)等3个参数与获得SVR密切相关.结论 HCV基因型为非1B型、治疗前低水平HCV RNA复制和获得EVR可作为肝移植后丙型病毒性肝炎复发抗HCV治疗疗效的有效预测因子.

Abstract：

Objective To investigate the efficacy of pegylated interferon (Peg-IFN) plus ribavirin to treat hepatitis C virus (HCV) recurrence, and analyze possible factors associated with sustained viral responses (SVR). Methods The enrolled 39 patients, who had recurrence of hepatitis C after liver transplantation and received antiretroviral therapy, were analyzed. Treatment was discontinued in 21 patients due to side effects, and the remaining 18 patients [13 males, 5 female,median age of 54 (27-67) years, treatment duration of 25-105 weeks)] were subjected to whole standard treatment. During the treatment, HCV RNA was measured at 4, 12, 24, and 24 weeks after HCV negative change as well as drug withdrawal. SVR was defined as HCV RNA negativity within 24 weeks after the drug withdrawal. The following variables were analyzed: ages, gender,pretreatment viral load, genotype, early viral response (EVR), levels of alanine aminotransferase before treatment and their association with SVR. Results The mean treatment duration was 57weeks with an SVR achieved in 4/18 (22. 2 %). Statistical analysis revealed that the genotype of non1B (P=0.023), RNA ＜106 copy/ml (P= 0. 044) before treatment and EVR (P=0.019) were the variables associated with SVR. Conclusion Genotype of nor-1B, low level RNA before treatment and EVR were the effective predictors of interferon antiviral therapy for recurrent hepatitis C after liver transplantation.     

肝移植后丙型病毒性肝炎复发治疗时获得持续病毒应答的影响因素

Objective To investigate the efficacy of pegylated interferon (Peg-IFN) plus ribavirin to treat hepatitis C virus (HCV) recurrence, and analyze possible factors associated with sustained viral responses (SVR). Methods The enrolled 39 patients, who had recurrence of hepatitis C after liver transplantation and received antiretroviral therapy, were analyzed. Treatment was discontinued in 21 patients due to side effects, and the remaining 18 patients [13 males, 5 female,median age of 54 (27-67) years, treatment duration of 25-105 weeks)] were subjected to whole standard treatment. During the treatment, HCV RNA was measured at 4, 12, 24, and 24 weeks after HCV negative change as well as drug withdrawal. SVR was defined as HCV RNA negativity within 24 weeks after the drug withdrawal. The following variables were analyzed: ages, gender,pretreatment viral load, genotype, early viral response (EVR), levels of alanine aminotransferase before treatment and their association with SVR. Results The mean treatment duration was 57weeks with an SVR achieved in 4/18 (22. 2 %). Statistical analysis revealed that the genotype of non1B (P=0.023), RNA ＜106 copy/ml (P= 0. 044) before treatment and EVR (P=0.019) were the variables associated with SVR. Conclusion Genotype of nor-1B, low level RNA before treatment and EVR were the effective predictors of interferon antiviral therapy for recurrent hepatitis C after liver transplantation.     

肝移植后丙型病毒性肝炎复发治疗时获得持续病毒应答的影响因素

Objective To investigate the efficacy of pegylated interferon (Peg-IFN) plus ribavirin to treat hepatitis C virus (HCV) recurrence, and analyze possible factors associated with sustained viral responses (SVR). Methods The enrolled 39 patients, who had recurrence of hepatitis C after liver transplantation and received antiretroviral therapy, were analyzed. Treatment was discontinued in 21 patients due to side effects, and the remaining 18 patients [13 males, 5 female,median age of 54 (27-67) years, treatment duration of 25-105 weeks)] were subjected to whole standard treatment. During the treatment, HCV RNA was measured at 4, 12, 24, and 24 weeks after HCV negative change as well as drug withdrawal. SVR was defined as HCV RNA negativity within 24 weeks after the drug withdrawal. The following variables were analyzed: ages, gender,pretreatment viral load, genotype, early viral response (EVR), levels of alanine aminotransferase before treatment and their association with SVR. Results The mean treatment duration was 57weeks with an SVR achieved in 4/18 (22. 2 %). Statistical analysis revealed that the genotype of non1B (P=0.023), RNA ＜106 copy/ml (P= 0. 044) before treatment and EVR (P=0.019) were the variables associated with SVR. Conclusion Genotype of nor-1B, low level RNA before treatment and EVR were the effective predictors of interferon antiviral therapy for recurrent hepatitis C after liver transplantation.     

新型直接抗HCV药物与免疫抑制剂相互作用研究进展

肝移植是目前治疗丙型肝炎病毒(hepatitis C virus,HCV)相关终末期肝病及肝癌的最有效手段.然而,HCV 受者肝移植术后 HCV 复发十分普遍.近年来,移植术后以直接抗病毒治疗药物(direct acting antivirals,DAAs)为基础的抗丙肝方案的临床应用取得了显著效果,但也有排斥反应发生...     

Kasai手术对胆道闭锁儿童行活体肝移植术的影响

目的 评价肝门-空肠吻合术（Kasai 手术）对胆道闭锁儿童行活体肝移植术治疗效果及预后的影响。 方法 对 2006 年 9 月—2014 年 9 月实施的 150 例活体肝移植患者资料进行回顾性分析, 其中 90 例受者先行 Kasai手术, 后接受活体肝移植（Kasai 组）; 60 例受者直接接受活体肝移植（非 Kasai 组）。 比较 2 组受者的一般资料、术后 并发症和累积生存率的差异。 结果 受者年龄为 4.9~87.0 个月 。 Kasai 组受者在移植时的移植月龄、体质量、身高 均高于非 Kasai 组, 而儿童终末期肝病（PELD）评分、术前胆红素水平则低于非 Kasai 组（均 P < 0.05）。 2 组移植物质量与受者体质量比（GRWR）、手术时间、术中失血量比较差异无统计学意义（均 P > 0.05）。 2 组受者的肺感染、急性排斥反应、门静脉吻合口狭窄、门脉血栓、肝动脉闭塞、胆漏、胆肠吻合口狭窄等发生率差异无统计学意义（均 P >0.05）。 Kasai 组肝移植术后总体并发症发生率为 61.1%, 高于非 Kasai 组的 43.3%（χ2=4.580, P=0.032）。 全部患者中 死亡 7 例（4.7%）, 其中 Kasai 组 6 例（4.0%）, 5 例为多器官功能衰竭, 1 例严重的肺感染; 非 Kasai 组 1 例（0.7%）, 因术前消化道出血急诊手术死于多器官功能衰竭。 供者均无严重并发症及死亡。 全部受者术后 1 个月 、1 年、3 年和 5年累积生存率分别为 98.6%、96.6%、94.9%, 92.7%。 其中, Kasai 组分别为 98.9%、96.5%、93.8%、91.3%; 非 Kasai 组分别为 98.3%、96.6%、96.4%、95.5%, 2 组比较差异无统计学意义（χ2=1.490, P=0.222）。 结论 胆道闭锁患者在 Kasai术后行活体肝移植术可获得满意的临床效果, 不会增加移植术后主要并发症的发生率及死亡比例, 长期生存率与未接受 Kasai 手术的患者相当。 且 Kasai 手术可推迟行肝移植的时间、利于儿童生长发育、减轻移植术前黄疸。     

肝移植术后丙肝复发抗病毒治疗患者持续病毒应答影响因素分析

目的分析肝移植术后丙肝复发抗病毒治疗患者产生持续病毒应答(SVR)的影响因素。方法回顾性分析2003～2009年39例肝移植术后丙肝复发并进行抗病毒(聚二乙醇干扰素和利巴韦林)治疗的患者的临床资料。结果本组中21例因不良反应停药,18例完成全疗程规范治疗,疗程25～105周;有4例(22.22%)获得SVR,其平均治疗周期是57周。统计分析显示,非ⅠB型基因(P=0.023)、治疗前丙肝病毒载量<10~6 copies/ml(P=0.044)以及早期病毒应答(EVR)(P=0.019)与SVR的获得有关。结论非ⅠB基因型、低水平HCV RNA和EVR是肝移植后丙肝复发抗病毒治疗产生SVR的影响因素。     

骨髓间充质干细胞与移植免疫的研究进展

骨髓间充质干细胞是目前倍受关注的一类具有多向分化潜能和高度自我更新能力的组织干细胞.除具有支持体外造血、促进体内造血功能重构外,还具有较低的免疫原性和抑制异体T淋巴细胞增殖的作用,在调节移植免疫方面发挥着重要作用.     

肝移植术后丙肝复发的临床分析

摘要 目的: 丙肝复发是很普遍的而且会导致5-10年内20-30%的患者进展为肝硬化,早期监测移植术后HCV复发的危险因素能够帮助医生进行抗病毒治疗。本文肝移植后丙肝复发患者的资料进行回顾性研究,对危险因素进行评价,以期丙肝的防治提供参考依据。方法: 收集2006年4月～2009年11月间在天津第一中心医进行同种异体肝移植术的丙肝患者资料加以分析总结,随访期大于3个月资料齐全者被纳入本次研究。共有患者44人,其中男性37人,女性7人,平均年龄57.84（39-76）岁,随访时间3-42月。检查术前及术后HCVRNA水平以及组织学和临床后果。常规给予FK506＋MMF＋Pred三联或无激素二联免疫抑制药物,于术后定期检测患者的肝功能、免疫抑制剂（FK506）血药浓度、HCVRNA水平,分析肝移植术后丙肝复发的的影响因素。结果: 肝移植术后丙肝复发患者有31例,复发率达70.46%。术前及术后早期HCVRNA>104丙肝复发率显著升高（P<.01）。年龄大于65岁复发率高于65岁以下患者(P<.05)。使用干扰素抗病毒治疗较未治疗患者病毒转阴率升高（P<.05）。合并巨细胞病毒感染以及免疫抑制剂的使用方案与复发无关。结论: 1. 肝移植术前及术后早期HCVRNA复制水平是影响肝移植术后丙肝复发和预后的重要因素。2、肝移植术后使用干扰素抗病毒治疗的疗效是肯定的。